Provider Demographics
NPI:1679568257
Name:WEBB, LARRY E (OD)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:E
Last Name:WEBB
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:757 E LEWIS AND CLARK PKWY
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47129-2269
Mailing Address - Country:US
Mailing Address - Phone:812-288-8566
Mailing Address - Fax:812-284-2326
Practice Address - Street 1:757 E LEWIS AND CLARK PKWY
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47129-2269
Practice Address - Country:US
Practice Address - Phone:812-288-8566
Practice Address - Fax:812-284-2326
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1236DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77012367Medicaid
KYU29576Medicare UPIN
KY0959008Medicare PIN
KY77012367Medicaid
KY5375220002Medicare NSC